Wednesday, August 29, 2012

A new APTA podcast and transcript provide an overview of the manual medical review process for Medicare claims for beneficiaries who reach $3,700 in outpatient therapy expenditures in a calendar year.

Under the new therapy cap exceptions process, outpatient therapy patients will still be eligible for an automatic exception at the 2012 therapy cap level of $1,880. Therapists will follow the same process of applying the KX modifier on the claim form when a patient exceeds the cap amount. Claims for patients who then meet or exceed $3,700 in therapy expenditures will be subject to a manual medical review process that will be implemented in 3 distinct phases beginning October 1, November 1, and December 1. (See last week's News Nowarticle for more information about provider assignment to the phases.)

Additional information regarding the therapy cap and the manual medical review process is available on APTA's website. CMS also provides a fact sheet and question-and-answer document regarding the process. Next week, APTA will record a webinar that will address the therapy cap and the manual medical review process. News Now will provide a link to the recording, which will be free to members, when it is available.